Q-I have an embarrassing problem that I cannot discuss...

Q-I have an embarrassing problem that I cannot discuss with my doctor. There are times when I just lose my water, and I can`t do anything about it. Does this mean back to diapers for me, or have they come up with any treatments to help older folks like myself?

A-While incontinence is more frequent in older people, it is found in all age groups. At least one estimate puts the number of Americans who suffer from incontinence at more than 10 million adults, so you have company.

Incontinence refers to the situation where there is a loss of ability to control urination. It can be divided into two classifications. ``Urge``

incontinence means that the person cannot hold urine long enough to make it to the bathroom. About 25 percent of people with the problem have this type. In another 25 percent, it is associated with ``stress`` incontinence, where urine leaks out during physical events, such as laughing, coughing or lifting heavy things.

Stress incontinence often occurs during the last months of pregnancy, when the enlarged uterus pushes down upon the bladder. In many cases, the exact cause of the incontinence cannot be found even after diligent examination.

However, if you`re to get the treatment you need-and there are several that can help-you will have to confide your problem to your doctor, for only after proper examination can a successful treatment strategy be developed. There are essentially four ways to treat incontinence: behavioral therapy, drug therapy, electric stimulation and surgery.

Behavioral therapy takes time and patience to learn, and helps you become more aware of the muscles used in controlling urination. Kegel exercises are used to strengthen the voluntary muscles that affect urination. You might also be placed on a strict schedule for urination, in the beginning as often as every hour, to retrain the muscles of your bladder. Gradually this time can be increased. After six weeks of training, almost 85 percent of the patients achieve good results, with 10 percent to 15 percent of those gaining complete control.

Drugs can be used to help increase the bladder`s capacity and to reduce involuntary muscle spasms that can cause you embarrassment. Spasms cause your muscles to contract at the worst moment, affecting the bladder when you`re not prepared. In some cases, using electrical stimulation of the bladder muscles can help you regain control.

When all these methods do not produce the results you desire, surgery can be used to either increase bladder capacity or to disrupt the nerve impulses that lead to spasms by blocking certain nerves.

It`s hard to know which method or combination of methods would work best in your case. That can only be worked out after you have been tested by your physician. You must be willing to try out new therapies if the first attempts are less than satisfactory.